News About Health Insurance
A timeline of changes in the health reform law
By Bob LaMendola, Sun Sentinel
7:07 p.m. EDT, June 19, 2010
New coverage coming for pre-existing conditions. But high-risk pools will cover only a few, at high prices.
By Bob LaMendola, Sun Sentinel
7:07 p.m. EDT, June 19, 2010
Multiple sclerosis patient Marc Fladell and millions like him hope they will benefit when the first major piece of national health reform begins this month.
Fladell, 47, needs lots of treatment in his 18-year battle with multiple sclerosis, but he lost his job and then his extended health insurance ran out two years ago. No insurer will touch him because of his illness, leaving him to pay his own medical bills of $300-plus per month.
The MS lets the Pompano Beach attorney work only part-time, so he often skimps on or skips medical care. He stopped going to the doctor for pain in his limbs or torso; he just ices down and takes the pain. If he gets the flu or other symptoms, he may see a nurse at a drugstore. His costly MS drug comes free from a manufacturer charity program, but when he needs other drugs, he often goes without them.
Now Fladell is warily hopeful because the government on June 23 will start to roll out "high-risk pools" in each state offering guaranteed coverage to people with pre-existing conditions.
"I would love to have insurance. I would pay whatever I have to, although I can't afford too much," Fladell said. "I didn't ask for MS. MS chose me. I just want the same ability to get insurance as everyone else has."
Yet experts say the $5 billion program will cover only a fraction of those who need it, and the coverage will be expensive.
Moreover, if Florida's experience is any indicator, the cost could be prohibitive: The state's experiment with a high-risk pool in 1982 collapsed in less than a decade because of spiraling expenses.
Covering the uninsured was among the top priorities of the health reform law passed by President Obama and Congress, especially for those who have been refused coverage or charged huge premiums because they have cancer, heart disease or even conditions such as asthma.
The high-risk pool program is a temporary fix, lasting until the main part of health reform launches in 2014 with insurance exchanges that will offer guaranteed coverage for all and subsidies for many.
The temporary pools will be open to all those with pre-existing conditions who have been uninsured for at least six months. Insurers or public agencies selling policies in the pools cannot charge more than for a typical individual policy on the open market. That may cut premiums by half or more compared with policies available now, although the prices will likely vary widely.
The pools should be most helpful to people age 55 to 64 who are more likely to be ill and are too young for Medicare, said Sara R. Collins, of the non-profit health policy group the Commonwealth Fund.
The pools end "this costly and unfair practice that allowed insurance companies to cherry-pick the healthiest beneficiaries while denying coverage" or charging chronically ill people higher premiums, House Speaker Nancy Pelosi said this month.
But the coverage will not be ideal. The average family health policy in Florida is $1,200 a month. The pools need cover only 65 percent of medical costs. Patients will have to cover co-pays, although no more than $5,950 a year for an individual, $11,900 for a family under the new law.
Nor will it cover everyone. Congress set aside $5 billion to run the pools through 2013, of which $351 million goes to Florida. Experts on all sides agree that's a drop in the bucket compared to the need.
Of the 50 million uninsured Americans, about 7 million have pre-existing conditions and will be eligible for the program. A study for the National Institute for Health Care Reform found that the program will have enough money to cover about 200,000 of them.
In Florida, the program will be able to cover maybe 30,000 of an estimated 500,000 eligible people, said Jerry Ashford, executive director of the Florida Comprehensive Health Association, a tiny high-risk pool set up by the state.
It's still unclear how officials would choose which Floridians will qualify — perhaps by first-come, first-served basis, by lottery, by financial need. But making it fair will be difficult, Ashford said.
"It's going to be sort of a gold rush race to get to the pot of gold," Ashford said.
Barring some other action, the rest will continue as they have been. If the money runs out early, experts said officials will have to find more cash, scale back benefits or drop the number covered.
Many other key questions remain unanswered until the U.S. Department of Health and Human Services completes rules for the program:
Will the rules be done by June 23, the law's deadline for the program to start? Will it accept people with partial coverage that excludes their illnesses? Will it take people with coverage but paying huge premiums? What are the maximum premiums? Can the program come together fast enough to let people start buying coverage on Aug. 1, which is an unofficial target date?
Despite the flaws and uncertainties, officials said the pools are worth doing.
"That's 30,000 people who weren't covered before, and that's a good thing," said Laura Goodhue, executive director of Florida Community Health Action Information Network. "I guess the message is help is on the way. We wish state or federal officials could do more."
Plantation accountant Alan Scharf doubts he will be eligible because he's insured at the moment. He has COBRA insurance at $339 a month from a past job with a company. But it's about to run out and because he had prostate cancer two years ago, he said he will have to pay at least $900 a month for a worse policy.
It's unclear who will run the pool in Florida. The state and 18 others declined to run their own pools and will let HHS run it or choose a carrier to do it.
Florida had its own high-risk pool starting in 1982 that covered as many as 7,000, but it collapsed under huge medical costs of the sick people who enrolled, said Randy Kammer, vice president of regulatory affairs and public policy for Blue Cross Blue Shield of Florida.
The state put no money into the pool and premiums paid by patients covered only a fraction of the costs, Kammer said. Fees paid by insurers covered the rest, but when the losses reached tens of millions a year, legislators agreed to close the program to new people in 1991. Today, only 250 people are still covered, the smallest state-run pool in the nation.
Thirty-three other states are using pools to insure 200,000 chronically ill people, which is why health reform planners borrowed the idea.
Kammer said the new pools will have lower premiums than the older state pools. That will mean higher losses but better coverage for the chronically ill.
Who might benefit? Maybe Laura Gelber, 57, a Hollywood real estate agent who works at a lunch counter to make ends meet.
Gelber said she can barely afford $1,100 a month — with a $10,000 deductible — she now pays for a policy through a former employer for her family of four. The price is high because her husband has diabetes and her college-student son has a gastrointestinal condition. The policy expires this month, and Gelber said the only policies available would cost $3,000 a month.
Like Fladell, she is skeptical the new high-risk pools would be affordable: "You will be able to get coverage. You will pay through the nose for the coverage, but you will not be shut out for coverage."
Washington correspondent William E. Gibson contributed to this report.
Health insurance for the under-26 crowd
By Julianne Pepitone, staff reporter
May 12, 2010: 11:42 AM ET
NEW YORK (CNNMoney.com) -- The federal government unveiled details this week about how people up to age 26 can get covered by their parents' health insurance policies, as part of the health care reform law.
Consumers now have details about how one of the law's most-buzzed about provisions will actually work -- and how much it will cost them.
Expanding health coverage to twentysomethings is welcome relief for an age group that accounts for the majority of uninsured Americans.
Roughly 30% of young adults up to age 26 have no health insurance at all. That's three times the rate of uninsured children, according to the Department of Health and Human Services.
HHS estimates that about 1.2 million young adults will elect to stay on a parent's health plan in 2011 as a result of the reform.
Here's what you need to know about the new regulations.
Who's covered: The law takes effect for insurance plans that already cover dependents, starting on or after Sept. 23, 2010.
Those plans will cover policyholders' children until age 26 -- even if those adult children no longer attend college, don't live with their parents and aren't dependents on a tax return.
Finally! We can get health insurance
Under-26 children who were previously dropped from dependent coverage will also be able to re-enroll as long as they don't have access to an employer-sponsored plan.
If an adult child has access to another employer-sponsored health plan, insurers can generally refuse coverage, but only until 2014.
Also, the re-enrollment option only applies to plans that already offer dependent coverage. If a company has such a plan, it must inform employees their children, who may have aged out of the plan, will be eligible again starting Jan. 1, 2011.
The policy applies to married and unmarried children, but does not extend to their spouses or children.
How much it will cost: Insurers must treat all dependents the same, regardless of age. That means that companies cannot jack up costs or limit coverage for the under-26 group.
Parents will face a 0.7% increase in insurance premiums, across the board, for adding dependents to their plans, according to HHS. That will rise by an additional 1% in 2012 and in 2013. "[E]ither ... stockholders or consumers" will shoulder that extra cost, HHS said in its report.
For those who enroll in the dependent coverage, the average policy will cost $3,380 for each dependent in 2011; $3,500 in 2012; and $3,690 in 2013, according to HHS's mid-range estimates. Those extra costs are tax-deductible.
How to get it: More than 65 health insurers have said they are now offering dependent coverage ahead of the September deadline.
But it's up to individual employers to decide when to offer the provision, and experts say most companies will opt to do that during open enrollment. That period typically happens in early fall.
For plan-years that start on or after Sept. 23, insurers must give qualifying young adults a 30-day window to enroll, according to HHS.
By RICARDO ALONSO-ZALDIVAR, Associated Press Writer Ricardo Alonso-zaldivar, Associated Press Writer – Fri Apr 23, 5:58 am ET
WASHINGTON – President Barack Obama's health care overhaul law is getting a mixed verdict in the first comprehensive look by neutral experts: More Americans will be covered, but costs are also going up.
Economic experts at the Health and Human Services Department concluded in a report issued Thursday that the health care remake will achieve Obama's aim of expanding health insurance — adding 34 million to the coverage rolls.
But the analysis also found that the law falls short of the president's twin goal of controlling runaway costs, raising projected spending by about 1 percent over 10 years. That increase could get bigger, since Medicare cuts in the law may be unrealistic and unsustainable, the report warned.
It's a worrisome assessment for Democrats.
In particular, concerns about Medicare could become a major political liability in the midterm elections. The report projected that Medicare cuts could drive about 15 percent of hospitals and other institutional providers into the red, "possibly jeopardizing access" to care for seniors.
The report from Medicare's Office of the Actuary carried a disclaimer saying it does not represent the official position of the Obama administration. White House officials have repeatedly complained that such analyses have been too pessimistic and lowball the law's potential to achieve savings.
The report acknowledged that some of the cost-control measures in the bill — Medicare cuts, a tax on high-cost insurance and a commission to seek ongoing Medicare savings — could help reduce the rate of cost increases beyond 2020. But it held out little hope for progress in the first decade.
"During 2010-2019, however, these effects would be outweighed by the increased costs associated with the expansions of health insurance coverage," wrote Richard S. Foster, Medicare's chief actuary. "Also, the longer-term viability of the Medicare ... reductions is doubtful." Foster's office is responsible for long-range costs estimates.
Republicans said the findings validate their concerns about Obama's 10-year, nearly $1 trillion plan to remake the nation's health care system.
"A trillion dollars gets spent, and it's no surprise — health care costs are going to go up," said Rep. Dave Camp, R-Mich., a leading Republican on health care issues. Camp added that he's concerned the Medicare cuts will undermine care for seniors.
In a statement, HHS Secretary Kathleen Sebelius sought to highlight some positive findings for seniors. For example, the report concluded that Medicare monthly premiums would be lower than otherwise expected, due to the spending reductions.
"The Affordable Care Act will improve the health care system for all Americans, and we will continue our work to quickly and carefully implement the new law," the statement said.
Passed by a divided Congress after a year of bitter partisan debate, the law would create new health insurance markets for individuals and small businesses. Starting in 2014, most Americans would be required to carry health insurance except in cases of financial hardship. Tax credits would help many middle-class households pay their premiums, while Medicaid would pick up more low-income people. Insurers would be required to accept all applicants, regardless of their health.
The U.S. spends $2.5 trillion a year on health care, far more per person than any other developed nation, and for results that aren't clearly better when compared to more frugal countries. At the outset of the health care debate last year, Obama held out the hope that by bending the cost curve down, the U.S. could cover all its citizens for about what the nation would spend absent any changes.
The report found that the president's law missed the mark, although not by much. The overhaul will increase national health care spending by $311 billion from 2010-2019, or nine-tenths of 1 percent. To put that in perspective, total health care spending during the decade is estimated to surpass $35 trillion.
Administration officials argue the increase is a bargain price for guaranteeing coverage to 95 percent of Americans. They also point out that the law will decrease the federal deficit by $143 billion over the 10-year period.
The report's most sober assessments concerned Medicare.
In addition to flagging provider cuts as potentially unsustainable, the report projected that reductions in payments to private Medicare Advantage plans would trigger an exodus from the popular alternative. Enrollment would plummet by about 50 percent. Seniors leaving the private plans would still have health insurance under traditional Medicare, but many might face higher out-of-pocket costs.
In another flashing yellow light, the report warned that a new voluntary long-term care insurance program created under the law faces "a very serious risk" of insolvency.Health Care Reform Timeline for Small Businesses
By LITA EPSTEIN, AOL SMALL BUSINESS
Posted: 2010-03-25 12:37:11
Getty Images
Under the new health care reform law, small businesses will find major changes to how they must provide health coverage and how much they must pay for it. Small businesses with more than 50 employees who don't offer health insurance may have to pay a tax penalty. Here's a breakdown of when and how the new health care law will affect you as a small business owner:
TIMELINE OF HEALTH CARE REFORM
Health care reform starting immediately:
More From AOL Small Business
-- For tax years 2010 through 2013, small businesses with 25 or fewer employees that pay average annual wages of less than $50,000 and purchase health insurance for their employees will be eligible for a tax credit of up to 35% of the employer's contribution toward the employee's health insurance premium, as long as the employer contributes at least 50% of a benchmark premium.
Small businesses with 10 or fewer employees who have annual wages of less than $25,000 will be eligible for full credit.
The tax credits phase out as firm size and average wage increases.
Tax-exempt small businesses that meet the above requirements are eligible for up to 25% of the employer's contribution toward the employee's health insurance premium.
Health care reform starting in 2011:
-- States will begin to get funding to establish the state-based health insurance exchanges for small business and individuals one year after the bill is signed into law. This funding will be available through January 1, 2015.
-- Small business employers will be eligible for grant money if they establish wellness programs. These funds will be available for five years beginning in fiscal year 2011.
Health care reform starting in 2013:
The tax deduction for employers who receive Medicare Part D retiree drug subsidy will end effective January 1, 2013.
Health care reform starting in 2014:
--Small businesses with up to 100 employees will be able to buy insurance for their employees using the Small Business Health Options Program (SHOP). These will be exchanges administered by a governmental agency or non-profit organization in their state.
--States do have the option to allow businesses with more than 100 employees to purchase coverage on the SHOP exchanges.
FEES OF HEALTH CARE REFORM
Any employer who does not offer coverage but has more than 50 employees and has at least one full-time employee who receives a premium tax credit will have to pay a fee of $2,000 per full-time employee. The first 30 employees will be excluded from this assessment.
Any employer with more than 50 employees that offers coverage but has at least one full-time employee receiving a premium tax credit will pay the lesser of $3,000 for each employee receiving a premium credit or $750 for each full-time employee.
Small businesses with 50 or fewer employees are exempt from any penalties.
If you do offer coverage to employees paid less than 400% of the Federal Poverty Level (http://www.census.gov/hhes/www/poverty/threshld/thresh09.html), you may be required to offer a free choice voucher for them to buy on the state-based individual exchange. This could happen if the share of the premium the worker pays exceeds 8%, but is less than 9.8% of their income. In this scenario, the worker can choose to purchase their insurance through the state-based exchanges.
Employers with more than 200 employees must automatically enroll employees into health insurance plans offered by the employer. Employees can choose to opt out of coverage.
HEALTH CARE REFORM TAX CREDITS
Eligible small businesses that purchase coverage through the SHOP exchanges will be eligible for a tax credit of up to 25% of the employer's contribution toward the employee's health insurance, provided they are paying for at least 50% of the premium. This credit will be available for two years, but Congress can choose to extend it. If they do, it would require new legislation.
Employers with 10 or fewer employees and average annual wages of less than $25,000 will be eligible for a full tax credit based on the employer's contribution to the health insurance premium.
The tax credits phase out as firm size and average wage increases.
TYPES OF PLANS UNDER HEALTH CARE REFORM
The law provides for four types of health care plans to be offered on the small business and individual exchanges:
- Bronze plan: Covers 60% of the benefit costs of the plan with an out-of-pocket limit equal to the Health Savings Account (HSA) current law limit of $5,950 for individuals and $11,900 for families.
- Silver plan: Covers 70% of the benefit costs of the plan with the HSA out-of-pocket limits.
- Gold plan: Covers 80% of the benefit costs of the plan with the HSA out-of-pocket limits.
- Platinum plan: Covers 90% of the benefit costs of the plan with the HSA out-of-pocket limits.
Jill Lawrence
Columnist
Health Reform: A Year-by-Year List of What Happens and WhenPosted:
03/26/10
President Obama and Democrats in Congress have come to the end of a 14-month health care odyssey. The result is a historic new health law that will make sweeping changes in our health system over the next few years. They include new consumer protections, coverage of millions of uninsured people, penalties for individuals and businesses who don't buy insurance, attempts to control rising costs, and Medicare savings and new taxes to pay for it all. Here is a year-by-year look at what's in store:
2010
Adults who can't get coverage because of a pre-existing medical condition can join a high-risk insurance pool (this is an interim step pending the launch in 2014 of competitive health insurance marketplaces and premium subsidies).
Insurance companies will have to issue policies for children with pre-existing conditions. They will not be allowed to revoke existing policies if people get sick. Lifetime limits on coverage will be banned in new coverage and annual limits will be restricted. Preventive services will be fully covered, with no co-pays or deductibles. Coverage will be available for dependent children until they turn 26.
Certain small businesses will start getting tax credits to offset up to 35 percent of the cost of insuring their employees. That will rise to 50 percent in 2014.
Plans must have "an effective appeals process" for decisions and claims. States will get grants to set up programs that help consumers with complaints or questions about health insurance. The federal government will set up a website to help people in different states figure out their insurance options.
The first tax increase kicks in: A 10 percent tax on indoor tanning services.
2011
Medicare changes will include free annual wellness visits; little to no cost-sharing for preventive care, like immunizations and cancer screenings; bonuses to primary care doctors and general surgeons; a new Center for Medicare and Medicaid Innovation to test ways to provide better, more efficient care; and, the start of a phase-out of overpayments to private Medicare Advantage insurers. People in the prescription "doughnut hole" will receive discounts on prescriptions.
2012
There will be new money for primary care services and new incentives to encourage doctors to join together in "accountable care organizations." The government will track re-admission rates at hospitals and impose penalty fees on hospitals with the highest rates.
2013
This is when higher taxes will begin for households with income above $250,000 and individuals above $200,000. The Medicare payroll tax on earnings above those amounts will rise from 1.45 percent to 2.35 percent. Unearned income above those amounts, such as dividends, will now be subject to a 3.8 percent tax.
In addition, maximum contributions to pre-tax Flexible Savings Account contributions will be limited to $2,500 a year (down from the current $3,050 for individuals).
There will be a new 2.9 percent excise tax on medical devices.
Medicare will sponsor a national pilot program on "payment bundling" -- paying hospitals, doctors and other providers based on patient outcome, not services provided.
2014
More consumer protections begin. Insurance companies will not be able to deny policies to anyone based on their health status or to refuse coverage of a treatment based on pre-existing health conditions. Their ability to charge higher rates to people based on age, geography, family size or tobacco use will be limited. Annual limits on coverage will be abolished.
Each state will open a health insurance exchange, or marketplace, for individuals and small businesses without coverage. People will be able to comparison shop for standardized health packages. There will be a multistate private plan available nationwide, supervised by the U.S. Office of Personnel Management. Tax credits will be available to make insurance and care affordable for people who make too much to qualify for Medicaid, but have incomes below 400 percent of poverty.
Most people will be required to buy insurance coverage or pay penalties that start at $95 in 2014 and rise to $695 or 2.5 percent of income in 2016. Employers with 50 or more workers who do not offer coverage will have to pay annual fees.
Medicaid eligibility will increase to 133 percent of the poverty level ($14,404 for individuals) for everyone under 65 (when they qualify for Medicare).
2015
A new Independent Payment Advisory Board will be formed to come up with ways to lower Medicare costs and promote better care. The recommendations will go to Congress and private insurers.
2018
This is when the most controversial new tax begins, a 40 percent excise tax on insurance companies and plan administrators for any family plan that costs more than $27,500. The tax applies to the cost above that threshold. There are higher thresholds for retirees over 55 and plans that cover workers in high-risk jobs.
2019
The new system will have reduced the number of uninsured people by 32 million, according to the nonpartisan Congressional Budget Office. That will leave an estimated 23 million uninsured, one-third of them illegal immigrants. Coverage of legal residents too young for Medicare (under age 65) will be 94 percent, up from 83 percent now.
05/08/09 | For Gay Couples, Obstacles to Health Insurance
By Walecia Konrad
Greg Sailor for The New York Times
“IT’S not easy being gay,” said Mary Jo Hudson, director of the Ohio Department of Insurance. She wasn’t referring to political opposition and other obstacles, but the plight of same-sex couples who are trying to get and keep health insurance.
Mary Jo Hudson, director of the Ohio Department of Insurance, is familiar with the difficulties in getting health insurance for a gay partner.
“You’ve got to go through a lot of hoops,” said Ms. Hudson, who is gay and has lived with her partner for eight years.
Same-sex couples have been making headlines; Maine followed the lead of Iowa and Vermont this week in legalizing same-sex marriage, and several other state legislatures are now considering it. But Ms. Hudson says that fairer and more comprehensive health care coverage for partners — whether they are legally married or not — is not necessarily part of the package.
“For the vast majority of gay couples,” she said, “getting health insurance for a domestic partner is still a challenge.”
Currently about one-third of companies with more than 500 employees offer domestic partner benefits. That’s up from about 12 percent in 2000, according to a study from Mercer, an employee benefits consulting firm. But the percentage drops off sharply when smaller employers are counted, Ms. Hudson said.
And there is no provision for domestic partner benefits for federal employees, although there are some legislative efforts to change that. Some states and municipalities offer their employees domestic partner coverage, depending on the state laws.
Even if the relationship is formalized with the state in a marriage or union, that does not always obligate the employer to cover a same-sex spouse. For one thing, self-insured employers are not regulated by the states.
And other benefit-providing employers that choose not to offer such coverage can sometimes use the Defense of Marriage Act — a law that forbids the federal government to recognize same-sex marriage — to trump state laws, said Ilse de Veer, a principal with Mercer.
On the flip side, self-insured employers are free to offer domestic partnership benefits, whether or not a state recognizes unmarried relationships. And some employers limit their domestic partner benefits only to homosexual couples, on the rationale that heterosexual couples can get married, while in most states gay couples still cannot.
If you’re part of a same-sex couple and you’re fortunate enough to work for an employer that will provide coverage for your partner, the process can still be cumbersome and costly. Here are some of the basics.
DOCUMENT YOUR RELATIONSHIP Many employers and insurance companies require proof of a domestic partnership before you can qualify for benefits. One of the most common documents is an affidavit signed by both partners, explaining the details of the relationship. For more information on what needs to be included in an affidavit, the Web site insure.com offers a check list.You may also need to provide copies of jointly signed leases, homeowners’ insurance policies, joint bank account statements and other legal documents that show the two of you live together and are financially intertwined.
Many states, counties and cities, including New York City, have domestic partnership registries where unmarried couples can legally register their relationships. Registration is not the same as a marriage certificate, but it is a good way to prove the legitimacy of your relationship to employers and insurers, Ms. Hudson said.
PREPARE TO PAY MORE TAXES Unlike married couples, domestic partners must pay federal and sometimes state taxes on health care benefits. That’s because the Internal Revenue Service counts the value of the domestic partner’s benefit as income for the employee. What’s more, pretax dollars from an employee’s flexible spending accounts or health savings accounts cannot be used to cover the domestic partner’s benefits.
Let’s say, hypothetically, that the cost for a partner benefit is $10,000 a year, and the employee is at the 40 percent marginal tax bracket. In addition to the share of premiums the employee pays, he or she would pay about $300 a month in taxes.
“That really adds to the cost of the benefit,” Ms. Hudson said. “It may be why so few couples take advantage of domestic partner benefits when they are available.”
She cited a Williams Institute study that shows unmarried partners are two to three times more likely to be uninsured than married people.
Ms. Hudson says that in rare cases, companies have been willing to increase employees’ paychecks to make up for the extra tax burden. So be sure to ask your human resources department about this.
A POSSIBLE TAX EXCEPTION For some people, there may be a way around the tax bind.
If your partner lives in your household for the entire tax year, receives 50 percent of his or her support from you and generally meets the criteria laid out in section 152 of the tax code, then you are legally entitled to receive domestic partnership health benefits tax-free. A lawyer or accountant well versed in domestic partnership law can help determine if you’re eligible for this break.
“This break is confusing and misunderstood because it is a special exemption for health care benefits only,” said Ms. de Veer. “Employers don’t always understand this part of the code themselves, so they often fail to tell employees about it. Lots of couples are paying taxes on health benefits that don’t have to.”
To determine if your partner receives 50 percent support from you, fill out the worksheet on page 33 of I.R.S. Publication 17, at www.irs.gov/pub/irs-pdf/p17.pdf
COVERAGE FOR CHILDREN Most employers that cover domestic partners also cover the children of that partner, considering it a parental relationship on the employee’s part, even if it has not been formalized legally.
With individual policies, though, depending on the insurer, you may have to prove you are a legal custodian of your partner’s child, said Ms. Hudson.
“Filing for custody rights is probably something you should do anyway,” advises Ms. Hudson. “You’ll need that document for everything from signing school permission slips to getting health benefits.”
WHAT ABOUT COBRA? If you are covered under your partner’s employer-sponsored insurance, and your partner is then laid off, many firms will offer you the opportunity to buy the same health care coverage for up to 18 months under the federal law known as Cobra. If the relationship ends, you may also be able to elect Cobra coverage, just as you would if you were divorcing.
Because Cobra is a federal law, employers are not obligated to offer this coverage to unmarried partners, but many do, says Ms. de Veer. As with all Cobra coverage, you must be sure to make the election within 60 days of the last day of coverage under the employer’s plan.
05/05/09 | Walgreen offers free health care for jobless
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CHICAGO (Reuters)
Adults, without insurance, who have lost their jobs on or after March 31 can have certain lab tests free.
Walgreen Co.'s Take Care health clinics are offering free visits for the rest of the year to those who lose their jobs and have no insurance.
The offer, which comes more than a year into the recession that has included thousands of job cuts, only applies to adults who lose their jobs on or after March 31. Spouses, domestic partners and children also qualify if they do not have their own health insurance.
Quest Diagnostics Inc. is offering certain free laboratory tests, such as strep throat and urine cultures, as part of the "Take Care Recovery Plan" announced Tuesday.
To qualify for the free visits, individuals must prove they are receiving or will receive government unemployment benefits. The free services are being offered weekdays from 11 a.m. to 3 p.m.
04/27/09 | Be proactive. Plan ahead and shop around.
By Francesca Lunzer Kritz
From the Los Angeles Times
Unless you've been rushed to the hospital in an emergency, the time to start thinking about paying the bill for hospital care comes as soon as your doctor says you need to have a test, procedure or surgery.
"What patients have to pay hospitals is not set in stone," says Mark Rukavina, executive director of the Access Project, a Boston-based health reform advocacy organization.
Hospitals do have a master list of charges, based on that hospital's cost of delivering care. Under California law, however, hospitals are required to offer discounted or free care to patients who meet financial eligibility guidelines. And most will negotiate with any patient having difficulty paying the bill, says Jan Emerson, a representative for the California Hospital Assn.
Rukavina advises having such discussions before care takes place. "That can ease the shock of seeing staggering numbers on a bill, just as you're recovering from surgery," he says. It can also enable the hospital's billing office to help find some assistance, such as Medicaid, Medicare or private and hospital charity assistance if the patient is eligible.
But uninsured patients retain the right to negotiate even after hospital care has been given, with the best deals often offered to people who agree to share their financial information and show a willingness to start paying the bill.
It's virtually impossible, however, to negotiate charges once they've been paid by credit card or after a bill has been sent to a collection agency.
Here are some tips on managing a hospital bill:
Talk with your doctor
For starters, get a full picture of what will be done during your stay, as well as any related tests and follow-up visits. "Don't be shy about speaking with your physician; the bad economy is no secret to them," says Dr. Dev GnanaDev, head of the California Medical Assn.
If you're worried about paying for the hospital care, ask whether it's safe to delay the treatment or procedure. Perhaps you need surgery for a sinus condition that's bothersome but not life-threatening. A delay, if approved by your doctor, is an especially good idea if you or a spouse is in line for a job that will pay health benefits or if you've maxed out your flexible spending account for the year.
Also ask if there are tests that can be avoided safely, such as for cholesterol and glucose if you've recently had those checked.
Compare hospital costs
Some insurance company websites, such as those for Cigna and Health Net, can tell you what many area hospitals charge insurers.
If you have insurance -- and have to pay a percentage of the bill -- finding the least expensive hospital can lower your share. (You'll need to ask your doctor about the hospital's quality and to help find a specialist there to do your procedure or surgery.) A recent search on Health Net's site found that a caesarean section in Southern California ranged from $18,000 to $30,000, excluding doctor costs. At a 20% coinsurance rate, the patient's share would range from $3,600 to $6,000.
If you don't have insurance, and thus don't have access to an insurer's site, you can get similar data from for-profit companies and use it to negotiate with a hospital. HealthGrades.com charges $7.95 for reports that give the average cost of what an insurer is charged and what the average charge is from a hospital in a particular region.
Get your insurer's OK
Insured patients, once you've settled on a hospital, contact your insurer to get approval for the care (not doing so could mean the insurer will refuse to pay) and to see what it will cover. Some billing experts recommend having your doctor detail the procedure and any pre- and post-care you may need, in writing, for the insurer. Add a copy of that to the file you should now be keeping -- having paperwork can help you rectify any billing errors that come up later.
Factor in the hospital deductible
Hospital stays typically have their own deductible, which could be $1,000 or higher, separate from the one you pay for outpatient care.
Expect hospitals to ask for the deductible and any other patient share of the bill on or before service. You don't always have to pay the deductible or your share of the hospital bill immediately, but you do have to come up with a plan to pay it off, says Bernadette Lodge-Lemon, head of patient business services at UCLA.
Cautions Rukavina: "Try to avoid using a credit card to pay a hospital bill, unless you're sure you'll be able to pay it off in full by the due date." Letting the credit card bill go past one cycle adds interest fees and could increase your interest rate. A better idea is to ask the hospital for a no-interest rate payment plan.
If you can't foot your share of the bill, hospitals might be able to discount your deductible, copay or coinsurance if you qualify under its financial screening process.
Check out possible assistance
If you're not insured, meet with a financial counselor at the hospital as soon as possible. Hospitals are required by law to let patients, insured or not, know about the availability of charity care, discounts and government programs that can cover all or part of their bill and about any other programs that can help take care of hospital charges, according to the California Department of Consumer Affairs.
The California Office of Statewide Health Planning and Development's website lets you find out the charity and discount provisions at area hospitals. Go to http://syfphr.oshpd.ca.gov/. You may qualify for free or discounted care if your income is below 350% of the federal poverty level (currently about $36,400 per year for one person or about $74,200 per year for a family of four) and you don't have health insurance of any kind, or you do have health coverage, but your medical costs are more than 10% of your family's income in the last year.
Some hospitals, including Cedars-Sinai and the UCLA medical centers, frequently offer discounts to both uninsured and insured patients with incomes higher than 350% of the federal poverty level, so don't be afraid to ask.
Get an itemized statement
Insured patients will typically get a summarized billing statement; the insurer gets more specific cost information. Request an itemized bill and ask the hospital for deciphering help if needed. More than 50% of hospital bills reviewed by his company has errors in them, says Jason Beans, head of Rising Medical Solutions, a patient billing consulting firm in Chicago. Errors, which average 9% to 10% of a total bill, can include errant decimal points, charges for tests or procedures not done, even care on days you weren't in the hospital.
"Look at each item and make sure the care occurred," says Beans. Do the dates match up? Were you charged for the same medicine or procedure twice? You can even ask about charges you think were unnecessary. For example, if you recently had a cholesterol blood test, but the bill shows another one you were not told about beforehand, question the charge, Beans suggests.
For incorrect items on the bill, direct your questions to the hospital, says Beans, unless the error was made by the insurance company, such as how much your deductible is, or if it disqualified a service you think it covers.
Ask yourself: Do I really need to go to the hospital?
One way of saving money might be to avoid the hospital for some care.
Cigna, which insures about 375,000 people in Southern California, recommends to its members that they consider having some tests and procedures, such as colonoscopies, MRIs and CT scans, done in independent surgery or imaging centers, or at an accredited doctor's office, which can save hundreds of dollars.
Hospitals can have far higher expenses, including a large physical plant, a larger staff and the need to write off millions of dollars in care for people who don't pay or who pay at a reduced cost. Your doctor should be able to recommend independent centers -- but, again, be sure your insurer will pay.
Don't ignore it
That bill for cancer surgery or an appendectomy or getting your meniscus fixed does have to be paid. Ignoring it will simply result in it being turned over to a collection agency.
"Pay your bills, even if you can only afford to pay a little at a time," says Rukavina.
03/17/09 | Some Relief from the High Cost of Health Insurance
By Karyn McCormack Karyn Mccormack
The rise in corporate layoffs over the last 15 months is leaving more people, especially those close to retirement age, scrambling to find health insurance they can afford. "It's the early baby boomers, in the 58- to 64-age bracket, who are the ones getting downsized," says financial planner Charles Auerbach, co-founder of Wealth Strategies Group in Cordova, Tenn. Not only do they lose their last years of income when they get laid off, the "insult to injury is they're going to see their health-insurance payments double or triple," he says.
Most people are elible to keep the health insurance they had with their former employer through COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) for 18 months after losing their jobs. But the premiums can be very expensive. Even so, terminated employees who have pre-existing health conditions will find that other individual plans may reject them or command an even higher premium with less coverage, making COBRA their best option.
Relief for millions of unemployed workers came on Feb. 17 with the American Recovery and Reinvestment Act of 2009 as part of the government's economic stimulus package. The new rule says eligible terminated employees will pay 35% of the premium to their former employer's health plan. The employer will subsidize 65% of COBRA premiums for up to nine months; in return the employer will receive a tax credit.
A Good Deal
This new rule applies to workers who lose their jobs between Sept. 1, 2008, and Dec. 31, 2009. Workers are not eligible for the premium reduction if they can get other group health coverage (such as a spouse's plan) or Medicare. Individuals must have maximum adjusted gross income of $125,000 (or $250,000 for married couples filing jointly; for more information check the Employee Benefits Security Administration's site at www.dol.gov/COBRA). "For the laid-off regular guy, it's a good deal," says Bart Zandbergen at Financial Management Network in Mission Viejo, Calif.
Rising costs have been at the center of the debate about health-care reform for the last few years. Many older adults can't afford health insurance. As of 2007, 7.1 million people (13% of the U.S. population) in the 50-64 age group were uninsured, up 37% from 2000, according to a report released by the AARP on Mar. 9. This number of uninsured older adults is expected to rise to 8.2 million by 2015. The average spending on premiums and services for individual insurance was $8,457 per year, vs. $4,103 for an employer plan (2005 data). Average out-of-pocket spending for those with individual insurance plans was more than twice as much as those with employer coverage. People with public coverage through Medicaid or Medicare also face high out-of-pocket expenses.
One in four adults aged 50-64 spends at least 10% of their disposable income on health care, says AARP. "These include insured adults for whom premiums are a stretch as well as insured and uninsured adults for whom the overall cost of care is a burden," says the AARP report. Some people in this age group are cutting back on prescription drugs and doctor visits, says AARP spokesman Jim Dau. "Eventually they can increase their health-care costs when they're older because they cut back on preventative care," he says.
In turn, health insurance has "become a much bigger part of someone's financial plan than in years past," says financial adviser Mark Kenison, president of Turning Point Financial in Charlotte, N.C., and Turning Point Benefits Group , which helps people living in North Carolina and South Carolina find health insurance plans.
A couple of Kenison's clients in their early 60s recently left or lost their jobs, so they needed to find health insurance to cover them until they qualify qualify for Medicare at age 65. "I just helped a guy, aged 62, who left his job -- they offered COBRA at $1,700 a month for him, his wife, and daughter. I found the same coverage from Blue Cross Blue Shield for $900," Kenison says. You can lower your cost by finding an individual plan with higher deductibles and co-pays, as well as a separate annual deductible for prescription drugs, he says. (If you choose a plan with a higher deductible, make sure you have enough money socked away to pay for health expenses until you meet the deductible.) Kenison has found lower-cost alternatives from Humana, Blue Cross Blue Shield, and Coventry Wellpath.
Pre-existing Conditions
If someone already has medical trouble, such as high blood pressure or heart conditions, they're going to find it much more difficult and expensive to get health insurance. One of Kenison's clients who has diabetes chose a limited benefits plan from AIM Health, which will cost less than the $1,200 a month policy quoted from Blue Cross Blue Shield, he says. But not all limited health plans are alike, and some may not cover you for emergency services or surgery, so make sure you evaluate what the plan covers for the lower price.
If you're not eligible for COBRA or can't find an individual plan that fits into your budget, check your local or state government to see if they have a group health plan. Some professional organizations also offer group plans.
03/05/09 | Obama begins push for healthcare reform with White House summit
NBC Nightly News (3/5, story 3, 2:50, Todd) reported that "Obama began his effort to reform the massive and complicated healthcare system, tying it to the economic crisis." Obama said, "It's one of the greatest threats not just to the well-being of our families and the prosperity of our businesses, but to the very foundation of our economy. And that's the exploding costs of healthcare in America today." NBC went on to report that "drawing on a lesson from Hillary Clinton's failed attempt to deal with healthcare in the early '90s, which was criticized for its secrecy...Obama opened up the process, inviting doctors, patients, business and labor leaders, even live streaming discussion groups on a new website, healthreform.gov." The CBS Evening News (3/5, story 6, 2:50, Couric) noted that the President contended "you can't fix the economy without fixing the healthccare system," adding (Reid) that he "boldly predicted quick success where so many before him have failed." Obama was shown saying, "Our goal will be to enact comprehensive healthcare reform by the end of this year." ABC World News (3/5, story 3, 2:30, Gibson) also covered the story.
The Wall Street Journal (3/6, Meckler) reports, "The sessions, which were open to the press and shown live on C-Span and the Internet, were in contrast to the approach" under Clinton, whose plan "was developed behind closed doors." Obama "appears to have learned another lesson from the Clinton administration's failed attempt, as shown by his promise that people who like their existing insurance plan would be able to keep it. One concern some had with the Clinton plan was that people might have to change their existing plans." The President is also "working to appeal to those who already have insurance by emphasizing that their costs would fall under his plan."
AFP (3/6, Collinson) also reports that "under the White House healthcare plan, which will likely be amended by lawmakers in final legislation, Americans who have health insurance and want to keep it can do so, though the administration says costs will lower." The plan would also "seek to lower the cost of prescription drugs, partly through relaxing rules on the import of medicines from other developed nations, and stop pharmaceutical giants blocking production of generic treatments."
According to the New York Times (3/6, A14, Pear, Stolberg), Obama "indicated for the first time that he was open to compromise on details of the proposal he put forth in the 2008 campaign. ... As a candidate, Mr. Obama said he would establish a public insurance program to compete with private insurers and would require employers to contribute to the cost of coverage for their employees or to the cost of the public plan. Insurers oppose the idea of a new public plan." The Times adds that "since the election, Mr. Obama has not restated the details of his campaign proposal, and he indicated Thursday that he would be pragmatic."
USA Today (3/6, Wolf) reports that "White House session...brought disparate factions together," and "Obama elicited promises of cooperation from lawmakers and stakeholders who in the past have been at loggerheads over how to fix the system. He and others emphasized areas of agreement and said they would work amicably on their differences." The summit "was notable for bringing interest groups together under one roof." USA Today adds that "insurers played the leading role in killing a healthcare overhaul in 1994, a point Obama noted."
The AP (3/6, Alonso-Zaldivar) reports, "The difference this time, Obama says, is that healthcare costs have become unsustainable, particularly in a sinking economy. The US spends $2.4 trillion a year on healthcare. Obama's goal is health coverage for everyone." The Washington Post (3/6, A2, Connolly), the Chicago Tribune (3/6, Levey), The Hill (3/6, Young), the Christian Science Monitor (3/6, Marks), the Financial Times (3/6, A1, Ward), Bloomberg News (3/6, Goldstein), UPI (3/6) and the UK's Guardian (3/6) also cover the summit.
08/07/08 | Congressional Bill Seeks to Lower Drug Costs
Congressional Quarterly (8/7/08, Parnass) reported, "Rep. Dennis J. Kucinich (D-Ohio) has introduced legislation (HR 6800) that would attempt to lower drugs costs by replacing the current prescription drug plan created by the 2003 Medicare overhaul law." The bill contains provisions to "allow patients to purchase drugs from an approved list of foreign countries, require Medicare to use its purchasing power to negotiate prices with the pharmaceutical industry, and impose limits on prices drug companies can charge if a drug's research and development was financed by taxpayers." The bill also calls "for no premiums, co-pays, or deductibles for drugs required by Medicare beneficiaries."
08/05/08 | Data Indicate Many Americans with Chronic Diseases Lack Health Insurance
The New York Times (8/5/08, C5, Abelson) reports that "[m]illions of Americans with chronic disease like diabetes or high blood pressure are not getting adequate treatment, because they are among the nation's growing ranks of uninsured," according to a study published in the Annals of Internal Medicine. This study is "the first detailed look at the health of the uninsured," and it "estimates that about one of every three working-age adults without insurance in the United States has received a diagnosis of a chronic illness. Many of these people are forgoing doctors' visits, or relying on emergency rooms for their medical care," the data indicated. For the study, lead author Andrew P. Wilper, M.D., of the University of Washington in Seattle, and colleagues, analyzed "government health surveys of adults ages 18 to 64 years old."
The researchers found that "23 percent hadn't seen a health provider in the last year, compared with six percent of the chronically ill who had insurance," Bloomberg (8/5/08, Blum) adds. The authors pointed out that some of these patients "may face early disability and death for lack of care," a result which is "at odds with statements by policy makers who argue [that] the 'predicament of uninsured persons is often voluntary and rarely consequential.'" Notably, uninsured people "who were chronically ill were six times more likely to list emergency [departments] as where they went regularly for care."
Focusing on some the study's details, HealthDay (8/4/08, Gardner) reported that the researchers used "data from interviews with almost 12,500 people...who had participated in the National Health and Nutritional Examination Survey." After analyzing the data, "the authors conclude[d] that an estimated 11.4 million working-age Americans with at least one of seven chronic medical conditions do not have health insurance." This number "included 16.1 percent of the 7.8 million people with cardiovascular disease, 15.5 percent of the 38.2 million people with hypertension, and 16.6 percent of the 8.5 million people with diabetes." The study also examined data on people with "asthma, high cholesterol, chronic obstructive pulmonary disease, or a previous diagnosis of cancer."
